N.H.’s Changing Workforce: When employees are caregivers

Published: July 2, 2010

NHBR recently held a roundtable discussion in conjunction with AARP New Hampshire to focus on caregiving — the need for caring for elderly parents by employees who must juggle multiple demands on their time and energy. Participants discussed the issue from a variety of perspectives — a caregiver, employers who are faced with adjusting to the growing need for flexibility and accommodations to assist employees faced with caregiving demands and providers who help caregivers find and provide assistance.Participants were:

Q. Caregiving is a reality in so many people’s lives in New Hampshire and across the country.

Elinor Ginzler: It’s an enormous issue. AARP has tracked this through surveys over the last 15 years. In 2009, we issued a report on caregiving across the life span — cradle to grave, as we call it. We identified that there are 65 million caregivers in the U.S. It is predominately still an issue about caring for older people, even within that cradle-to-grave frame, 70 percent of caregivers are taking care of someone who’s 50 years of age or older. Over three-fourths of care to older people who need assistance are getting it from families and friends.

Q. What is the picture in New Hampshire?

EG:AARP NH just put out a really good piece of research. In the national survey, we found that 22 percent of families are caregivers. In New Hampshire it’s higher — 31 percent of New Hampshire adults are caring for somebody. And New Hampshire is getting older. Today, 13 percent of New Hampshire’s population is 65-plus, and the age group of 85-plus is going to double between now and 2030. Since the older you are the more likely it is statistically that you’re going to need assistance, this is an issue that is going to grow.

Rosalynn Carter says there are four kinds of people in the world — people who are caregivers, people who were caregivers, people who will be caregivers and people who will need caregivers. It’s her way of saying this is an issue for everyone.

Pair all of this with the reality that more and more people are staying in the workforce longer and longer, and caregiving becomes an important issue in the workplace setting for employers.

Q. Tracey, what kind of services does the state provide to address the situation?

Tracey Tarr:The Bureau of Elderly and Adult Services has a very large and progressive program, called Transitions in Caregiving. Supported by federal grants, it shifts administration from our state office to a caregiver-directed, locally-managed model that allows caregivers to determine their needs with support from local resources through our ServiceLink resource center network.

The project includes training caregivers, but also the ServiceLinks have all hired caregiver support specialists who will meet with the caregiver, do an in-home assessment and help the caregiver identify what he or she needs in order to continue to provide care.

This program is really focused on the needs of the caregiver, and we’re seeing some really tremendous and wonderful results with that.

Q. When people need to get caregiving-related services, where would do they go?

TT:You can go to one of our ServiceLink resource centers, which are designated as the state’s aging and disability resource centers. It’s a place for anybody looking for information or assistance. There are referral specialists, long-term care counselors, Medicare specialists. It’s considered a model for the country, since we were the first ones to implement them.

EG:A survey conducted by AARP NH shows that employers can be very, very critical partners in caregiving in this respect, and in a way that’s not going to bankrupt them or put a burden on their HR department.

Mostly what employers can do is provide that information on the aging and disability resource center that’s nearest to their employees. Seventy-five percent of the employees surveyed said they would find it very helpful to have list of community resources, a set of information on where they could go to get help. That would be an enormous impact on their lives, and therefore their work as well.

Tammy Boucher:We went through ServiceLink, so that worked well for us for that initial contact. Where we started to drown was when you get in the process of Medicaid or applying for veterans benefits. Even once you knew what the resources were, you got handed a 60-page document that asked you questions only your dad would know — and dad has Alzheimer’s.

I have been working on veterans benefits for my father since October, and we still don’t have the benefits. We just finished filing for Medicaid benefits. I can’t even tell you the times I sat down and broke down into tears, overwhelmed. It’s a very daunting process and one that I think that you can’t be educated in.

Q. How did your caregiving responsibilities affect your working situation?

TB:I have an 85 and an 80-year-old parent and a 12 and a 7-year-old. The balancing act is quite challenging.

Four years ago, for a variety of reasons, I made the decision to start my own company because I needed the flexibility. I wanted to be able to be there for my parents and my kids.

It was at a point when I had a very lucrative job offer on the table, but it was going to take me out of the state for a significant amount of time. A part of me thought it was a job opportunity of a lifetime, and part of me realized my heart is here. I don’t regret the decision in any way, shape or form, but it has limited my opportunities and it has an economic impact on my family and my ability to give 150 percent anywhere because my attention is in so many different directions.

Q. Employers must run across situations like Tammy’s often.

Pat Donahue:A casual survey of our employees showed that at least 20 percent are dealing with caregiving right now. The majority are dealing with an elderly parent. The biggest impact is balance of workload and the stress that’s obvious in the work environment.

Our policies are flexible enough to allow for time off — we have flexible scheduling so they can arrange their schedules and have an extra weekday to take care of their parents. The Family and Medical Leave Act is available, and we manage that well — we have good participation in the program. But the work doesn’t go away, so really the thing that’s missing is how they manage that workload when they get back — especially for people who take extended time from the office.

Q. Is there a morale impact when someone takes extended time?

PD:The morale impact is so minimal you can’t even measure it — everyone’s very supportive because everyone knows they’re going to be in the same situation. The supervisors are compassionate about the situation and supportive of the need for time, however the work demands don’t go away. If the employee is in an exempt position, they put in additional time during the week. If not, their co-workers pick up the work.

Mary DeVeau:The VNA employs 330 people. Of the 330, 90 percent are women and the average age is 48 years old, so many of them are touched by caregiver needs — the elderly more than children.

Everybody on my senior team has been impacted by caregiving for a parent or an in-law. It is true the staff rallies around, helping each other out. We offer the flexibility to allow our employees to do that because they go into homes and see the strain on individuals. They do a lot of counseling, referring people to organizations like ServiceLink and making sure that before we discharge a patient, we’re setting that caregiver up as much as we can set them up.

It frustrates me that we have such a fragmented delivery system with silo-like rules and payment systems that don’t allow someone to come in at a single point of entry and be cared for, for lack of a better way of saying it. I think ServiceLink is the model to keep moving forward, but until we reduce the fragmentation, it’s very burdensome to help somebody to get care.

We tax society, whether it be the employer who has to give that person the time because the employee is probably coming back very tired, very stressed, at risk of injury, at risk of depression, at risk of abusive type behaviors that could be negative in the workplace, let alone their personal lives.

Q. Are most caregivers female?

EG:It’s a women’s issue on both sides. Women live longer than men, so more care recipients are women. Our trends show a little bit of shifting, but right now our ratios are about 60 percent women, 40 percent men.

Tammy’s story about giving up a promotion is right off the page of the research. Close to 70 percent of working caregivers have had to make an adjustment in the workplace because of their caregiving — most of which is going in late, leaving early, taking time off. But a specific percentage — about 10 percent — turned down promotions or new jobs with growth possibilities because of their caregiving, and another 10 percent have left the workplace completely because of their caregiving responsibilities. That is the ultimate loss of productivity, since there are costs associated with somebody leaving your place of business, and there are costs in recruiting someone new, hiring someone new, training someone new and having them come up to speed at the right level of productivity.

MD:I think one of the opportunities for employers is in flexible hours. We’re fortunate because we’re seven days a week, so we can do that. We’re also starting to think about and plan for working from home at all levels of our administrative staff.

We’ve also given our staff technology so they don’t have to show up at the office — a lot of the clinical information that they collect in a patient’s home can be transmitted over the phone line.

Q. What are some of the things that employers can do that they’re not doing right now to make their workplace more caregiver-friendly?

EG:Quite frankly, one thing an employer can do is for the light bulb to go off in their head — realizing this is an issue. You can’t overlook how critically important that first step is.

According to the AARP NH survey, there was good news and not-so-good news. Fifty-five percent of people responded said their employer offers flexible schedules, but 81 percent said they want it. While 55 is not bad, there’s a gap there.

Three-quarters of survey respondents said what they want is information — if their employer can give them information about community services it would be incredibly helpful to them.

We have an enormous disconnect in another place, which has to do with job-sharing. Fourteen percent of survey respondents said their employer offer shared work arrangements, but 43 percent think it’s very important. That’s something that doesn’t necessarily cost the employer a lot of money, but it would make a big difference.

PD: It strikes me as odd that we haven’t embraced the FMLA as much as employers could. The FMLA was structured on the basis of providing leave time exactly for this purpose, and the large employers are federally mandated to comply with it. My experience has been that not many employers are not as proactive about managing that benefit as they should be. They don’t communicate with their employees and employees are not aware that they are entitled to use that benefit or why it was created.

TT:We have a number of staff within our bureau who are dealing with caregiver issues, and we are really fortunate to have flexibility in terms of supporting them and helping them to take care of their needs. We also have easy access to our HR office, which is a great resources for people to explore and/or find out about FMLA. One of the great things that was implemented a few years ago is a donation system allowing people to donate sick time that can be used by people who need to take extended leaves. It’s a great way to help a co-worker, even those you may not know.

Q. The challenge of dealing with this issue is immense.

TB:It’s a challenge trying to figure out how I am going to run my own company, in my case, pick up my kids, go to the nursing home and have dinner with dad and deal with any other issues that mom has, then go home and make dinner so we can get to the baseball game. Then you have your spouse and their parents. By the end of that, there’s nothing left. And when you do that for a long period of time, it’s a huge, huge commitment.

TT:The whole societal piece that I think people don’t think about, especially with working caregivers, is if those caregivers can’t take care of the person, and then they have to access services. Then the whole thing falls apart — financially and societal.

It’s a very big dilemma because the two caregiver programs that we do have are meant to provide temporary respite for the caregiver. The demand is increasing among people for ongoing services. We get many calls from working caregivers who want to maintain their jobs, but they have a family member who needs much more comprehensive services than they can just get from respite services.

MD:I think another of the challenges that as a society we really haven’t taken a hard look at is those individuals who have a higher income who are living off Social Security, who may have their own home, who may have some dividends coming in, and those are the people who would benefit tremendously from a little bit of help to stay in the community instead of even considering impoverishing them to get them into a nursing home or into the Medicaid program.

Q. There seem to be two aspects to this – what you as an individual needs to know and what an employer need to know.

EG:It’s important to recognize that. From the caregiver perspective, part of the message is to empower them, to feel that it is OK for them to acknowledge that this is a role they have, that they are going to need support from their employer, that they are a valued employee. So it’s in the employer’s best interest to give support and the message to the employer is that it’s in your best interest — your bottom line. If you’re in business to make money, you’re going to make more money if you take care of this segment of your staff, and you can do that without spending an enormous amount of money.

The other reality is that most of the education that’s done today in the U.S. on retirement finances doesn’t factor in long-term care costs. You go to these seminars — they aren’t looking at long-term care needs.

They are looking at important areas that people haven’t saved for, but if you get to age 65, there’s a two-thirds chance you’re going to need assistance with activities and daily living.

PD:The employer has a huge role to play in that. We bring financial planning to the employees, we bring other kinds of information. We can bring caregiver planning to employees and offer it in the workplace at no cost. It’s just providing the opportunity and the time and space. We just did a wellness fair with all kinds of wellness vendors around the room. Caregiving was not a topic, and yet I’m sitting here now saying, “My goodness — what an opportunity.”

MD:I think the light bulbs will turn on because society is going to have to deal with an aging workforce, an aging population with a lot of needs, and the laws have changed where people won’t be able to transfer money to their children — there’s a lot of change happening, and it’s going to happen pretty rapidly.

EG:I like to think we are a can-do country. After World War II, we didn’t plan properly for the baby boomers, and communities across the U.S. had to respond to the influx of bodies into their populations, but we built schools and got teachers into those schools, and we adjusted. We’ve got to hurry up now, but we can do this — we can respond in the same way we responded to the boomers when they first came around.

For more information about resources for employee caregivers:When Employees Become Caregivers – A Manager’s Workbook

N.H.'s Changing Workforce is a collaboration between NHBR and AARP New Hampshire.

This article appears in the July 2 2010 issue of New Hampshire Business Review